Clinical Predictors of Abnormal Esophagogastroduodenoscopy (EGD) Findings in Children

Introduction: To evaluate potential predictors as well as age-specific predictors of abnormal esophagogastroduodenoscopy (EGD) results in children undergoing first EGD. We focused on indications for EGD and documented endoscopic and histologic abnormal findings in different age groups in children aged 0-13 years. Methods: This was a retrospective study of children aged 0-13 years who underwent their first EGD from July 2006 to July 2013 in a pediatric GI center in a regional-referral teaching hospital. Demographics, clinical EGD indications, gross, and histologic EGD findings of the study population were collected. Potential predictors were assessed via univariate and multivariate analysis. Univariate analysis included chi square and Student t test; multivariate analysis was done with logistic regression using a forward stepwise algorithm. Results: During the study period, 749 patients were identified as having had an initial EGD. The 3 most common indications found were failed medical management (51.4%), abdominal pain (45.8%), and vomiting (34.7%). The 4 most common abnormal findings were gastritis (21.9%), reflux esophagitis (12.8%), celiac disease (9.1%) and eosinophilic esophagitis (8.3%). Figure 1 indicates the increase of prevalence of abnormal EGD by age. Three significant predictors of abnormality were found in our study population, which included age (odds ratio [OR] 1.13; p<0.001), black race (OR 2.3; p=0.001), and positive celiac panel (OR 1.9; p=0.007). With age-based analysis, black race remained as a predictor in children <2 years (OR 3.68; p=0.002); bloating/flatulence in children aged 2-7 years (OR 3.6; p=0.014); and female gender (OR 0.49; p=0.01) plus unspecific diarrhea (OR 0.03; p=0.28) in children aged 8-11 years. No factors remained significant for children aged 12 years and older.Figure 1Conclusion: Predictors found in this study for abnormal EGD results in children aged 0-13 years were older age, black race, and had positive celiac panel. We also found that different clinical manifestations have age-based predictive value. Predictors of abnormal EGD results vary by age group. Age-adjusted predictors should be taken into consideration in developing EGD indication algorithm in children.